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Shadowing / Observership Inquiry
Banner-University Medical Center, Department of Surgery
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Name:
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Organizational affiliation (if applicable):
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Are you a medical student?
Yes
No
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Email:
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Are you an international student or physician?
Yes
No
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Are you under the age of 18?
Yes
No
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Date(s) of Proposed Visit:
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Hours/Duration of Proposed Visit:
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Please rank the top three specialties you would like to observe:
1st choice
2nd choice
3rd choice
Abdominal Transplant
Breast
Cardiothoracic
Colorectal
Endocrine
General Surgery
HPB (Hepatopancreaticobiliary)
Melanoma/Sarcoma
Minimally Invasive/Bariatric
Pediatric General & Thoracic Surgery
Trauma
Vascular
1st choice
2nd choice
3rd choice
Abdominal Transplant
Breast
Cardiothoracic
Colorectal
Endocrine
General Surgery
HPB (Hepatopancreaticobiliary)
Melanoma/Sarcoma
Minimally Invasive/Bariatric
Pediatric General & Thoracic Surgery
Trauma
Vascular
Clear selection
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